Decision-making and End-of-Life-care in Emergency (DandELinE) | Work Place Instruction Scope This work place instruction applies to <update to local context >. Purpose This work place instruction outlines the process for Decision-making and End-of-Life care in Emergency departments (ED), (DandELinE). The processes are designed to support ED staff when making decisions regarding care and treatment for patients at or nearing end of life. Instruction Caring for patients requiring a palliative approach in the ED can be difficult and stressful for all involved. Early identification of these patients can lead to more appropriate and timely decisions for treatment and disposition planning. The process includes: • Locating previous advance care planning documents/ discussion records; (Delete this box after reading – for information only) Note: Work place instructions are not published and are document controlled locally within the unit they are developed for. They are low risk and allow a level of flexibility. The responsibility for the instruction remains solely with the line manager of that unit/service. Please ensure your review the document and update the grey highlight text to locally contextualise this work place instruction. Definition Work Place Instructions (WPI) are documents which offer suggestions on a specific task to be undertaken in a specific location, e.g. the preparation process for opening/closing a clinic or how to use a specific piece of equipment. They are guidelines to best practice which can be related to clinical, managerial, operational and technical activities, within a particular work unit/area or service group.
Transcript
Decision-making and End-of-Life-care in Emergency (DandELinE) | Work Place Instruction
Scope This work place instruction applies to <update to local context >.
PurposeThis work place instruction outlines the process for Decision-making and End-of-Life care in Emergency departments (ED), (DandELinE). The processes are designed to support ED staff when making decisions regarding care and treatment for patients at or nearing end of life.
InstructionCaring for patients requiring a palliative approach in the ED can be difficult and stressful for all involved. Early identification of these patients can lead to more appropriate and timely decisions for treatment and disposition planning.
The process includes:
• Locating previous advance care planning documents/ discussion records;
• Identifying patients who are nearing end of life or imminently dying;
• Determining the appointed Enduring Power of Attorney (EPOA) for health matters or other legal substitute decision maker (SDM);
• Discussing treatment options with the patient or EPOA / SDM;
• Documentation of outcomes and discussion;
• Implementing the Care Plan for the Dying Person or the (ieMR) Palliative care manage-ment -adult, Terminal Phase, Interdisciplinary Plan of Care (IPOC);
• Medication prescribing guidelines for pain and symptom management;
• Disposition planning.
(Delete this box after reading – for information only)
Note: Work place instructions are not published and are document controlled locally within the unit they are developed for. They are low risk and allow a level of flexibility. The responsibility for the instruction remains solely with the line manager of that unit/service. Please ensure your review the document and update the grey highlight text to locally contextualise this work place instruction.
Definition Work Place Instructions (WPI) are documents which offer suggestions on a specific task to be undertaken in a specific location, e.g. the preparation process for opening/closing a clinic or how to use a specific piece of equipment. They are guidelines to best practice which can be related to clinical, managerial, operational and technical activities, within a particular work unit/area or service group.
The DandELinE flowchart is not intended to be followed strictly in order, e.g. discharge plan-ning, may begin with the <update to local context> e.g. text - Patient Access Coordination Hub (PACH) team> prior to the patient arriving in ED.
All members of the interdisciplinary team should consider if the patient could be dying and to verify appropriateness of care at any time during the presentation. All staff are encouraged to engage in or respond to discussions regarding ACP with the patient, carer or substitute decision maker.
All required resources are available in the <update to local context e.g. text - DandELinE trol-leys located in acute and the Short Stay Unit procedure room>. It is expected that ED staff will increase their capacity to initiate and provide end-of-life care in the ED by using these re-sources. <update to local context e.g. text - The specialist Palliative Care team will continue to provide consult liaison support, as required>.
Locating previous Advance Care Planning (ACP) documentationThe triage process must include determining if the patient has any existing ACP documents (see Appendix 3). These may be filed in the health record or available on The Viewer in the ACP tracker. A history of ACP conversations and activity may also be available in the ACP tracker.
<Update to local context> e.g. text Refer to the procedure for Advance care planning – re-cording discussions and documentation.
Confirm that the documents are the most recent/ up-to-date and valid (signed and dated appro-priately) and bring these documents to the attention of the treating medical officer.
Identifying patients who are imminently dying or at risk of dying in the short termMedical officerDetermine what the patient hopes to achieve during this presentation. Establish their under-standing of their health care, elicit goals of care, values and preferences. Confirm with the pa-tient that any existing ACP documents remain current. If not, revoke where necessary and com-plete new documents.
When assessing the patient, consider:
• Does this patient show signs of advancing disease – unstable, deteriorating, complex symptom burden? Do they have an existing condition/s with a risk of dying from a sudden acute crisis in their condition?
• Is the patient showing signs of frailty or had frequent admissions recently for the same symptoms with little or no improvement?
• Will providing active or life prolonging treatments lead to a meaningful outcome that is in line with the patient wishes and their acceptable quality of life?
• What will be the benefit to the patient in performing diagnostic tests/ procedures?
• Would it be a surprise if the patient died within the next few days/ weeks/ months? How does the patient wish to spend these last days?
Seek consensus opinion and discuss with senior medical officer, as required. Health providers are under no legal or ethical obligation to offer or provide futile medical treatment (treatment that affords no benefit and would cause harm to the patient). Under the law, patients with capacity provide their own consent and may refuse life-sustaining treatment, even if this results in their death or would cause it to happen sooner.
Determine the appointed Enduring Power of Attorney (EPOA) for health matters or Substitute Decision Maker (SDM)ACP documents come into effect if the patient no longer has the capacity to speak for them-selves, engage in and consider all the available treatment / care options, and make decisions regarding their health care.
The Queensland guardianship legislation provides a consenting priority list for adults with im-paired capacity:
1. Advance Health Directive;
2. Tribunal appointed Guardian;
3. Valid EPOA (for health matters);
4. Statutory Health Attorney (over 18yrs old, readily available, willing and culturally appro-priate) in the following order:
a) Spouse in close and continuing relationship;
b) Primary unpaid carer;
c) Close adult friend or relative (not paid carer);
d) The Public Guardian.
Discussing treatment options with the patient or EPOA/ SDMDecisions and conversations with relatives and carers of patients about resuscitation status, ad-vance care plans and patient wishes can be difficult and should be handled in a sensitive, com-passionate and professional manner. The overall treatment plan should be discussed in the context of what can and can’t be done (within reasonable limits of what is achievable) for the patient in a sensitive, yet honest way. This conversation may include discussion, in broad terms, of available treatment options, palliative care and other support measures.
Remember to involve the Social Worker, Aboriginal and Torres Strait Islander Hospital Liaison Officer and Spiritual/ Pastoral care, if required.
If end-of-life care is not the appropriate and agreed decision, cease the DandELinE process and treat as required.
Documentation of outcomes and discussionDelicately handled conversations can relieve anxiety and avoid misunderstandings or unrealistic expectations further along the clinical path. Limitations must be clearly spelled out and be con-sistent with information already communicated. It is imperative to make a clear decision and
communicate it to all treating clinicians by providing details of these conversations clearly in the health record. The guardianship law includes a legal requirement to document the decision-making pathway.
<Update to local context> e.g. text Refer to the procedure Advance care planning – recording discussions and documentation.
Implementation of the care plan for the dying personNursing staff When the decision has been made to provide end of life care, retrieve the required documenta-tion pack and medication device pack from the DandELinE trolley. Record the UR number/ at-tach a patient identification label to the Trolley Stock Use Record (Appendix 6) and complete the form as items are used.
Non-ieMR sitesThe multidisciplinary team (MDT) should use the Care plan for the dying person, which con-tains:
• Details of the MDT involved in commencing the care plan;
• Initial assessment;
• Family/ carer information sheet (to be torn out and given to the family/ carer during dis-cussions);
• Ongoing assessment;
• Clinical notes section;
• Care after death.
The care plan supports the delivery of high-quality care tailored to the individual’s needs and forms a comprehensive ‘checklist’ of the essential elements of end of life care. The family / carer information ‘tear-out’ sheet is used to support the information provided in previous discus-sions with the patient / family during the decision-making process.
The ongoing assessment section presents symptoms in a ‘track and trigger’ format with prompts for management options.
Commencement of this care plan in the ED supports transition of care and facilitates clinical handover if the patient is transferred to another ward / facility.
ieMR sites use the Palliative Care Management Adult, Terminal Phase, Interdisciplinary Plan of Care (IPOC).
All end-of-life care patients in ED should be commenced on:• Palliative Care Management Adult
• Terminal Phase in the Interdisciplinary Plan of Care (IPOC) in ieMR, OR
Medication prescribing guidelines for pain and symptom managementMedical officer As a person reaching the end of life begins to deteriorate, their regular medications may not need to be administered. Cease any medications that are not required for comfort or symptom management, including IV fluids and in some instances, oxygen therapy.
The important medications to remember charting (particularly before the patient leaves the emergency department) are for pain, anxiety / agitation, increased secretions and nausea/ vomiting.
• Use the DandELinE PRN Medication Guideline (Appendix 4) which details the most fre-quently required medications to manage symptoms. The preferred route of administration is subcutaneous.
• Consider replacing the patient’s current symptom management medications with a continu-ous sub-cutaneous infusion (CSCI). The Palliative Care Consult Liaison team offer 24-hour support and assistance if required and are contactable via switchboard.
REMEMBER: Doses conversion may be required for patients who are currently receiving opioids.
Disposition planning/ transfer and accommodation of dying patientsPatient preferences are given priority when determining where best to care for the dying patient. Every effort must be made to quickly accommodate the patient in the most suitable area or pre-ferred location for their end-of-life care. Religious or cultural preferences should be accommod-ated wherever possible.
End-of-life care must be tailored to the individual needs of the patient and their family/ carers. Consider these needs when determining what information, resources and mementos (e.g. quilt) are provided. Provide bereavement support for families/ carers and staff as required.
Patient wishes to die at home or usual place of residenceSome patients, and/or their family or carers may wish for the patient to return home to be cared for through the end of life and after death. In most cases, palliative care support will be required for patient, family and carers.
If the patient is already known to Palliative Care, contact the Palliative Care nurse (in hours) if the management plan has been altered. After hours, contact <Update to local context> e.g. text Dove Palliative Care Unit.
If the patient is not known to Palliative Care, contact the Palliative Care registrar for referral. Discharging these patients after hours should be avoided, if possible.
Medical officer
Prescribe medications for symptom management and pain control. Notify the GP, provide a copy of the ARP and complete the “Not for CPR” letter. Appendix 5
Nursing staff If a patient arrives with a Niki pump insitu, ensure the Niki pump is returned with the patient. Provide the family / carer with the DandELinE information pack (available in the DandELinE trol-ley) including the family / carer section from the Care plan for the dying person; the Surefuser+ booklet (if required) and a copy of ‘The dying’ process.
If not previously provided by the Social Worker, include a copy of the <Update to local con-text> e.g. text ‘When someone dies booklet’ in the information pack. It may be appropriate to of-fer the patient a quilt, handcrafted and donated by the Sunshine Linus Inc. Quilters if they have not previously received one from the Adem Crosby Centre.
Social Worker and Aboriginal and Torres Strait Islander HLO
Provide resources as required for the individual patient.
Pharmacist If the patient is returning to a Residential Aged Care Facility, ensure the EDMAR and Subcu-taneous Medication Infusion Device Chart are completed.
Patients who wish to die in hospital / Palliative Care UnitMedical officer Refer patient for admission under the appropriate specialty and prescribe adequate medications for symptom management and pain control. Complete the Interim Management Plan (IMP) if ap-propriate or if not appropriate, discuss with admitting registrar regarding a rapid review.
Nursing staff Contact the <Update to local context> e.g. text PACH team to arrange/ confirm fast track ad-mission to the relevant ward or facility. Commence any prescribed continuous subcutaneous medications and provide care as per the Care plan for the dying person.
NOTE: Patients who are to be transferred from <Update to local context> e.g. text SCUH to another facility require:
A Surefuser+ ™ for continuous sub-cutaneous medications;
A copy of the ARP and the “Not for CPR” letter (Appendix 5).
NOTE: It may be necessary to use the <Update to local context> e.g. text Transit Unit (if ap-propriate) for patients who are waiting Inter-hospital transfer or transport home. The non-urgent non-ambulance (NUNA) vehicle may also be a suitable option for transferring patients to Palliat-ive Care Unit or a local Residential Aged Care Facility (RACF). Patients requiring transport are to be provided with a copy of the ARP and “Not for CPR” letter (Appendix 5).
Patients who are imminently dyingMedical officer Complete the Short Stay management plan (LINK) and prescribe medications for symptom management and pain control.
Nursing staff Transfer to room 15 in the Short Stay Unit, <Update to local context> e.g. text or Single Room bed 4 at NGH as soon as possible. Continue as per the (ieMR) Palliative Care Management Adult, Terminal Phase in the Interdisciplinary Plan of Care (IPOC).
<Update to local context> e.g. text See local procedure Care and management of deceased patients (adult and paediatric) and the supporting checklist.
References and further readingPrimary legislation, policy, standards or other authority
Guardianship and Administration Act 2000
Queensland Powers of Attorney Act 1998
Clinical Excellence Division: End of life care: Guidelines for decision-making about withholding and withdrawing life-sustaining measures https://www.health.qld.gov.au/__data/assets/pdf_file/0033/688263/acp-guidance.pdf
National consensus statement: essential elements for safe and high-quality end-of-life care ht-tps://www.safetyandquality.gov.au/wp-content/uploads/2015/05/National-Consensus-Statement-Essential-Elements-forsafe-high-quality-end-of-life-care.pdf
Statewide strategy for end-of-life care May 2015 https://www.health.qld.gov.au/__data/assets/pdf_file/0022/441616/end-of-life-strategy-full.pdf
Clinical Excellence Division: Advance Care Planning Clinical Guidelines January 2018 https://www.health.qld.gov.au/__data/assets/pdf_file/0037/688618/acp-guidelines.pdf
National Safety and Quality Health Service Standards 2nd ed – Comprehensive care
Other supporting documents
Advance health directive website and forms: https://www.qld.gov.au/law/legal-mediation-and-justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/advance-health-direct-ive/
Acute resuscitation plan form https://www.health.qld.gov.au/clinical-practice/guidelines-proced-ures/patient-safety/end-of-life/resuscitation/overview
Statement of choices (SoC) form A: For persons with decision-making capacity, and form B: For persons without decision-making capacity
Enduring power of attorney: https://www.qld.gov.au/law/legal-mediation-and-justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/power-of-attorney/
SCHHS Practice Development, Advance Care Planning: Introducing a Conversation Tool ID 000031
End-of-life Essentials: Education Modules, End of Life Directions for Aged Care https://www.el-dac.com.au/
Consultation Palliative Care team, Emergency Department clinicians, Director Pharmacy
Compliance
Palliative Care Management Adult, Terminal Phase, Interdisciplinary Plan of Care, (pa-tients dying in the ED)
IHT of dying patients with Care Plan for the Dying Person commenced in ED
90% of end-of-life care patients in the ED will be managed as per this pathway.
1. Discuss options and overall treatment plan with patient / SDM2. Consensus agreement that the person is likely to be dying3. Clinical decision to provide palliative approach to care4. Document in health record5. If required contact social worker <Ph No. X> or A&TSI HLO <Ph No. X>
Under the law patient with capacity may refuse life-sustaining treatment, even if this results in their death or would cause it to happen sooner.
Deterioration in patient’s condition indicates the patient could be dying
Consider the reversibility of this condition
Will providing active treatment or life sustaining measures: Align with the Substitute Decision Maker (SDM) or patient wishes? Lead to a meaningful outcome for this patient? Be consistent with ‘good medical practice’?
Treat condition as required MO - Discuss and record future management options and ARP with patient / SDM
Seek consensus opinion and discuss with senior medical officer
Yes No
Decision-making and End-of-Life-care in Emergency: DandELinE
YesNo
NoYes
Is the patient imminently dying?
Ensure bereavement support for the family / carer Support / debrief with staff as necessary Resources available in DandELinE trolley
Complete required documentation for deceased patients – see DandELinE trolley
Transit unit may be appropriate Transport – <Ph No. X> may be available for <X> transfers or <X> to <X>
Utilise the Surefuser™+ for transfers to other facilities
Immediate transfer to single room - SSU Rm 15
Continue as per Care Plan for the Dying Person and Ongoing Ax form
Provide adequate pain and symptom relief – consider subcut infusion
Transit Unit – <Ph No. X> as an alternative if required / appropriate
Complete Deceased Body Checklist as per local procedure - Deceased patient care and management: adult and paediatric patients
Admit
Contact PACH - <Ph No. X> to confirm / arrange fast track admission to relevant ward/facility
Refer for admission under appropriate specialist
Complete IMP and R/V end-of-life PRN meds
Subcut Medication Infusion Device Chart for inpatient
Cont. Care Plan for the Dying Person and Ongoing Ax form
Discharge
Contact: Pall Care – <Ph No. X> or switch
A/H re: - Advice re meds (Reg/Consultant A/H) - Arrange community follow-up (Nurse)
Pharmacy - <Ph No. X> in hrs., consider - ‘Scripts for subcut infusion & PRNs - EDMAR or IMAR (if Nursing Home patient) - Subcut Medication Infusion Device Chart for Nursing Home patient
GP – for follow-up / notification Provide required pain / symptom
relief Provide Information Pack inc. copy
of the ARP and “Not for CPR” letter
Does the patient prefer to die at home?
Commence the Care Plan for the Dying Person
Min 2hrly symptom assessment and comfort observation Follow the Care Plan for the Dying Person Ongoing Assessment form
Treating Medical Officer Complete / review ARP Contact Consult Palliative Care team as needed Review Medications
o Stop those not required for comfort (including IV fluids) o Aim for subcutaneous administration route o Chart end-of-life PRN meds
Dignity and comfort are the priority
Appendix 1: DandELinE Pathway For ieMR sites
6. Discuss options and overall treatment plan with patient / SDM7. Consensus agreement that the person is likely to be dying8. Clinical decision to provide palliative approach to care9. Document in health record10. If required contact social worker <Ph No. X> or ATSI HLO <Ph No. X>
Under the law patient with capacity may refuse life-sustaining treatment, even if this results in their death or would cause it to happen sooner.
Deterioration in patient’s condition indicates the patient could be dying
Consider the reversibility of this condition
Will providing active treatment or life sustaining measures: Align with the Substitute Decision Maker (SDM) or patient wishes? Lead to a meaningful outcome for this patient? Be consistent with ‘good medical practice’?
Treat condition as required MO - Discuss and record future management options and ARP with patient / SDM
Seek consensus opinion and discuss with senior medical officer
Yes No
Decision-making and End-of-Life-care in Emergency: DandELinE
YesNo
NoYes
Is the patient imminently dying?
Ensure bereavement support for the family / carer Support / debrief with staff as necessary Resources available in DandELinE trolley
Complete required documentation for deceased patients – see DandELinE trolley
Transit unit may be appropriate Transport – <Ph No. X> may be available for <X> transfers or <X> to <X>
Utilise the Surefuser™+ for transfers to other facilities
Immediate transfer to single room - SSU Rm 15
Continue as per Care Plan for the Dying Person and Ongoing Ax form
Provide adequate pain and symptom relief – consider subcut infusion
Transit Unit – <Ph No. X> as an alternative if required / appropriate
Complete Deceased Body Checklist as per local procedure - Deceased patient care and management: adult and paediatric patients
Admit
Contact PACH - <Ph No. X> to confirm / arrange fast track admission to relevant ward/facility
Refer for admission under appropriate specialist
Complete IMP and R/V end-of-life PRN meds
Subcut Medication Infusion Device Chart for inpatient
Cont. Care Plan for the Dying Person and Ongoing Ax form
Discharge
Contact: Pall Care – <Ph No. X> or switch
A/H re: - Advice re meds (Reg/Consultant A/H) - Arrange community follow-up (Nurse)
Pharmacy - <Ph No. X> in hrs., consider - ‘Scripts for subcut infusion & PRNs - EDMAR or IMAR (if Nursing Home patient) - Subcut Medication Infusion Device Chart for Nursing Home patient
GP – for follow-up / notification Provide required pain / symptom
relief Provide Information Pack including
copy of the ARP and “Not for CPR” letter
Does the patient prefer to die at home?
Commence the Care Plan for the Dying Person
Minim 2 hourly symptom assessment and comfort observation Follow the Care Plan for the Dying Person Ongoing Assessment form
Treating Medical Officer Complete / review ARP Contact Consult Palliative Care team as needed Review Medications
o Stop those not required for comfort (including IV fluids) o Aim for subcutaneous administration route o Chart end-of-life PRN meds
Dignity and comfort are the priority
Appendix 2: DandELinE Pathway for non ieMR sites
Advance Care Planning Documents
Acute Resuscitation Plan (ARP)An Acute Resuscitation Plan (ARP) are used in all Queensland Health facilities and are a clinician’s record of discussions with a patient or their substitute de-cision maker (SDM) about resuscitation planning if there is an acute event, e.g. cardiac or respiratory arrest.
It is not a legal document, nor does it substitute for legal consent. It is a clinician’s record and provides clinical authority to act when urgent decisions are required. An ARP can be valid for the current admission, until a specified future date, or subsequent admissions.
An ARP form should be reviewed from time to time, depending on recommendations from by the medical officer who completed the form or changes to the patient's clinical or personal cir-cumstances.
When a new ARP form has been initiated the superseded ARP form must be voided.
If a patient is transferred to another facility, the original ARP form must remain in their medical record at the original facility. The discharging medical officer may determine that it is appropri-ate for a copy of the patient's ARP form to accompany them and other medical records to the fa-cility to which they are being transferred.
The receiving facility/ treating team should consider the information on the copy of the ARP form and if appropriate, the treating medical officer should complete a new ARP form for use at that facility.
Advance Health Directive (AHD)An AHD is a legal document that formally records a patient’s instructions for fu-ture health care for a time when they may be unable to communicate their wishes.
AHDs come into effect only if the patient has lost capacity to make their own de-cisions.
Enduring Power of Attorney (EPOA)An EPOA is a legal document that enables a person to appoint another person or persons to make personal, health and/ or financial decisions on their behalf if they lose capacity to make their own decisions, e.g. if failing cognitive health.
Attorneys may be nominated to make decisions either independently or jointly.
Statement of Choices (SoC)SoC form A to be completed by persons with decision-making capacity, or SoC form B to be completed for persons without decision-making capacity.
Appendix 3: ACP Documents
The SoC is an advance care planning tool that focuses on a patient’s values, wishes and be-liefs. It can help a patient’s substitute decision maker to make healthcare decisions, if a patient is unable to make decisions for themselves. The SoC is not a legal document but a record of a patient’s preferences for health care. The information contained in this document can be used to guide management of care. Appropriate discussion of treatment or care options and consent for medical treatment still needs to be sought from the patient or their substitute decision maker. These discussions must then be documented in the health record.
The SoC can be completed by patients and/ or their families independently, or discussed and completed jointly with medical, allied health or nursing staff.
DandELinE - PRN Medication GuidelinesChart ONE PRN medication for EACH symptom
Anticipatory prescribing is recommended for all symptomsCheck ADR / Allergy for all medication options listed below
Symptom First Choice Second Choice PAIN / DYSPNOEA
NOTE: If patient pain remains poorly controlled after 2 hrs. or requires more than 3 - 4 prn doses within 6 hrs.: Contact Palliative Care for assistance with pre-
These doses are recommended for the opioid naïve patient – seek assistance as required for conversion of baseline medications. Call switch (9) for Palliative Care Consultant if required
Consider replacing the patient’s usual symptom management medications with a subcutaneous infusionIf uncertain about anticipatory prescribing for your dying patient or pain/symptoms remain poorly controlled after 1-2hrs, contact Palliative Care via switch.
Appendix 4: DandELinE - PRN Medication Guidelines
Draft text for a not for cardio-pulmonary resuscitation letter below. A template is provided at www.health.qld.gov.au/careatendoflife.
Date
<Affix Patient ID label>
Cardio-pulmonary resuscitation (CPR) is not appropriate.
This patient is in the advanced stage of an incurable disease.
During the recent inpatient admission, the matter of CPR has been fully discussed with this patient and/or next of kin and proxy decision maker. The patient and/or next of kin or proxy decision maker has decided that in the event of a cardio/respiratory arrest they DO NOT WISH to have CPR.
Should this patient die en route, please proceed to the hospital of destination or RACF or the patient’s home.
We have advised relatives / carers not to call an ambulance if the patient gradually loses consciousness or is found unconscious or unresponsive as part of the normal dying process.
In such circumstances, the relative/carer should instead contact the General Practitioner and/or the Community Nurse.
Dr <Full name>
<Position>
<Signature>
Appendix 5: Not for cardio-pulmonary resuscitation letter
Trolley stock use record | Decision-making and End-of-Life-care in Emergency: DandELinE Place a tick in the column when stock is used for end-of-life care patients in Emergency Department.
Attached ID label / provide UR number Date Niki pump pack used
Surefuser+ pack used
Info pack envelope given
“When someone dies/ booklet provide
Quilt given Memory box given
End of life care bag used
Appendix 6: DandELinE trolley stock use record
Supporting documentsType Title Document ID
Primary protocol/procedure/guideline
<Insert> <Insert>
Associated forms and templates <Insert> <Insert>
Related documents and references <Insert> <Insert>
Communication and Implementation PlanAction Responsible PositionList communication, education and training available to support implementation:
<Insert Action>
Instruction ApprovalApproval Date: / / Effective Date: / / Review Date: / /Approving Officer: <Insert name and title> Signature:
Supersedes: <This is the name and number of any document/s that this document replaces (including previous versions of the same document).>
Aligned to:
AcknowledgementsFunding for the development of the Decision-making and End-of Life-care in Emergency (DandELinE)Toolkit was provided by Clinical Excellence Queensland, Department of Health.
Development of the DandELinE Toolkit was a joint project between Sunshine Coast Hospital and Health Service and Clinical Excellence Queensland, Department of Health. The Clinical Excellence Queensland is committed to supporting projects which deliver better health outcomes for Queenslanders.
Acknowledgement of the Time is Precious (TIP) pathway developed by Liverpool Emergency Department, NSW which was adapted in the development of DandELinE.
